Healthcare Provider Details

I. General information

NPI: 1740277607
Provider Name (Legal Business Name): ADAM ROSS NORTICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WALKER CHAPEL PLZ STE 115
FULTONDALE AL
35068-3402
US

IV. Provider business mailing address

732 MONTGOMERY HWY # 304
VESTAVIA HILLS AL
35216-1800
US

V. Phone/Fax

Practice location:
  • Phone: 205-603-6820
  • Fax: 205-533-9941
Mailing address:
  • Phone: 205-603-6820
  • Fax: 205-533-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number16195
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number16195
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: